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Thread: just a cataract ?

  1. #1
    Join Date
    Apr 2007

    Default just a cataract ?

    AAPC: Back to School
    Work at an ASC and we do numerous cataracts. Most of them are straight forward, but one doc does something it seems always extra with the cataract. I think its all inclusive but here is operative report ,pleaselet me know what you think ?

    66684 ?

    POSTOPERATIVE DIAGNOSIS: 1. Visually significant cataract, O.D. 2. Pupillary membrane, O.D. 3. Synechial attachments between the small pupil and the lens capsule, O.D. 4. Status post trabeculectomy operation with glaucoma in the recent past, O.D.

    OPERATION: 1. Phacoemulsification with a posterior chamber intraocular lens implantation, O.D. 2. Pupilloplasty with synechiolysis, O.D. 3. Pupillary membrane removal, O.D. 4. Intracameral injection with Decadron 0.1 cc, O.D.

    After informed consent was obtained from the patient, the patient was wheeled into the operating room. The right eye was prepped and draped in the standard fashion for this procedure. Lids and eyelashes were secured with the help of a lid speculum. Preservative-free lidocaine, one drop x 3 was placed on the surface of the cornea and conjunctiva. Examination of the anterior segment was performed under the microscope. The cornea was clear and the anterior chamber was shallow. The pupil was small with synechial attachments within the lens of the pupillary margin and there was a pupillary membrane. The patient had a cystic bleb in the supratemporal quadrant.

    Paracentesis was performed in the supranasal quadrant. Viscoelastic was injected into the anterior chamber. A 2.75 mm Alcon keratome was used to enter into the anterior chamber in the infratemporal quadrant. With the help of the viscoelastic cannula, synechiolysis was performed. Then, using an Utrata forceps, the pupillary membrane was simply removed. Then continuous capsulorrhexis was performed with the help of cystotome. Hydrodissection was performed with the help of BSS on a cannula. Nucleus was removed with the help of phacoemulsification. The remaining cortical material was removed with the help of irrigation/aspiration. A posterior chamber implant was inserted in the capsular bag without any complications. The rest of the viscoelastic was removed from the anterior chamber. The wound was hydrated and closed with the help of two interrupted 10-0 nylon sutures. At the end of the operation, 0.1 cc of Decadron was injected to the anterior chamber. At the end of the procedure, the cornea was clear, the anterior chamber was deep and well formed, and the implant appeared to be stable within the capsular bag with a bright red reflex. A drop of pilocarpine, timolol, and TobraDex were placed in the eye and the eye was covered with the help of a shield. The patient was transferred to the recovery room without any complications.

  2. #2


    What I infer out of this is these:
    Procedures performed:-
    Injection anterior chamber of the eye (separate procedure)
    Paracentesis of anterior chamber (separate procedure)
    Anterior synechiolysis 65870 (to be reported)
    Removal of epithelial (papillary)down growth- 65900( if at all it was there)
    Phacoemuscification Posterior (extra capsular cataract removal intraocular lens implantation, requiring devices or techniques and primary posterior capsulorrhexis) -Complex-66982
    If he used operating Microscope then report with 69990.( not 66990)

    I would like to report this way: 66982, 65870, 65900-59 ; if too much time consuming and extra work than that of usual norms, you may append -22

    and if operating Microscope used then would include 69990 (because he documented microscope, I do not know what microscope was it)
    Do I make some sense!!!?

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